Saturday, November 16, 2013
Sadly, we are leaving the lovely respite of Hotel Perquin Lenka this morning and heading into Cacaopera for our last clinic (for now)... Though PINCC will return in 6 months to Certifiy the doctors and nurses trained this week in these procedures.
The area we are working in, the Dept. of Morazan, was the heartland of some of the most brutal battles during El Salvador's Civil War in the 80's. They were the heroes and Martyrs (FMLN - the Faribundo Marti Liberacion Front) who fought and died to win back their democracy from the brutal CIA-backed military at the time. Many of the women I have interviewed prior to their exam tell of losing fathers, husbands, sons and/or daughters during 'la guerra'.
Our team of 9 arrived in Cacaopera, a first visit for PINCC, to discover an amazingly clean, well-organized, well-staffed and well-run public health outpatient clinic.
They had pulled out all the stops and pulled doctors/nurses from other areas to make this a successful teaching experience. The women came from miles around, some walking to arrive here. The message was definitely out there that this was an important opportunity for them. We were all very relieved and gratified at the end of the day.
Monday, November 11, 2013
The Garden: Dagapur Tea Estate, Siliguri, West Bengal, India.
The tea plantation is referred to by local residents as 'The Garden'. It is a beautiful place and a difficult place. A very good description of India herself.
We have completed our week at the Dagapur Tea Estate. I am touched, inspired and deeply grateful for everyone who took part. Our remarkable team: Rhoda Nussbaum MD and John Adams PhD, the founders of PINCC, India. Ginger Ruddy MD the new medical director of PINCC. Debra Levinsky MD, Lauren Sokolik ARNP and myself Leonie Wolff RN, Vedic Master. We were joined by George Lewinsky, broadcast journalist for Link TV and David Betsill PhD.
PINCC was invited by Sumita Cancer Society (SCS) of Siliguri. We worked closely with the SCS President Papiya Sen and its founder MK Bhattacharjee. 'MKB' as he wanted us to call him, founded Sumita Cancer Society with his wife Sumita who passed away the same day it was dedicated. She died of ovarian cancer at age 27. Their vision was to offer education for cancer prevention and support for those living with cancer. Since Sumita's death in 2006 MBK has dedicated his life to this organization.
We were joined by volunteers from Sumita Cancer Society to assist us in all aspects of operating the clinic including administration, translators and of course the trainees in VIA. These mostly young, enthusiastic volunteers were eager to be trained and will provide a solid base as SCS continues to grow.
And the reason we were all there… The women of Dagapur Tea Estate. These women live hard lives picking and processing tea. They live simply and almost all are illiterate. It took bravery and trust on their part as we offered them health exams they had never experienced. An uncomfortable and personally invasive exam searching for an ailment they could not see or feel. I will carry their eyes and smiles in my Heart always.
While the large majority of those who came to the clinic were tea workers we had several members of the Sumita Cancer Society also get screened. And the day after the district director of the local police came by to see our camp, several women police officers came for VIA.
Bikram, the manager of the Tea Garden, partnered with Sumita Cancer Society to be the host site. His wife Sarvaprit, who is a school teacher in town, was the first person screened. The final evening they had us to their home for a celebration that included fireworks and a campfire.
We screened over 200 women in our 4 day camp and had surprising results. Cryotherapy was only required on 2 women. And no LEEP. These women were remarkably healthy! This is of course great news for their community although it decreased the opportunities for trainings. Pap and biopsy results will be interesting to receive.
We left with strong ties with the members of Sumita Cancer Society and the local community. We are optimistic that the PINCC program will continue to be supported and grow.
The photos of the Dagapur Tea Estate site include views of the clinic, tea plantation, some of our PINCC team and India volunteers.
What happens when your soul begins to awake in this world... To your deep need to love & serve life? Oh, The Beloved will send you... Wonderful & Wild companions! ~Hafiz
Leonie Wolff RN LMT Vedic Master
Sunday, November 10, 2013
Wednesday, November 6, 2013
What happens when your soul begins to awake in this world... To your deep need to love & serve life? Oh, The Beloved will send you... Wonderful & Wild companions! ~Hafiz
Monday, November 4, 2013
This is PINCC's first week of training at the Sumitra Cancer Society and 8 of us have survived the 24 hour + travel to reach a remote part of Northeastern India. We look at one another, exhausted, but enthused to be here "We Made It!" was exclaimed. After 2 months of roadblocks getting our newly required employment VISAs for volunteer work in India, I think we were all in a state of disbelief that we were really here. "T-I-I," our courageous and dedicated leader Rhoda Nussbam, MD reminds us, "This Is India."
Our first day was an auspicious one, arriving in time for Diwali, the country's well-known festival of lights, celebration, family, and FIREWORKS! The hotel had a delightful celebration that we were included in, a festive way to kick off the first week of training at this new site.
Today was our first day of official meetings and we were impressed by the preparedness of our Sumitra Counterparts- photocopies have been made, supplies gathered, trainees prepared, and the clinic organized for the camp- so far things are going smoothly. The Sumitra Office is a buzz of activity today as introductions are made, to-do lists are reviewed, and chai is served in small Dixie cups. We all start to relax a bit more as we gain confidence in the Sumitra organization's ability to meet our expectations for the camp.
This trip has special implications for PINCC India, in that the husband and wife team leaders who initiated PINCC's work in India about 5 years ago, Rhoda Nussbaum and John Adams, are passing the baton to a new group who will be taking over the India programs from here on out. John and Rhoda successfully developed two Cervical Cancer screening programs during their tenure and women's lives continue to be saved thanks to their dedication and expertise in medicine, organizational development, and persistence to work through the ever present challenges of working in India- "T-I-I!"
~Lauren Sokolik, MSN, FNP, Training for Administrative Role for PINCC India
Nov 4, 2013
Wednesday, October 30, 2013
Day 2 of the final Leon site visit and its amazing the difference from Day 1. For experienced PINCC volunteers this is probably a given, but as a first timer - it is really impressive!
The beauty of Day 1 however was the greeting our returning volunteers received from the hospital staff and trainees. Even for volunteers from years ago it was the welcoming of long lost friends and beautiful to see. The ensuing chaos was expected but everyone kept moving, kept calm, and by the end, 35 patients had been seen and several procedures done.
Day 2 was transformative though and beyond being impressed by tasks completed, I can now see the real magic that is happening here. Trainees who were unable discern what they were looking for on exams or in pt histories are showing remarkable vision even in one day of training. And volunteer trainers have achieved a much greater level of comfort in their roles as teachers, smiling, joking and cheering their students successes. A week seems time such a short time to be here but I am getting a sense of what can be accomplished in as little as that.
Of course every trek has its bumps scattered in the path so...from equipment held hostage at the airport, a computer that continues to digest inputted info to some invisible file but then eventually, thankfully, spits it out exactly where it should be; to our new favorite question "which is the room that had the nitrous leak???"; there are so many opportunities to go with laughter instead if dismay, and i love that this group choices laughter! Carol is an inspiring mentor in this regard and our Ambassador, Baby Nehru is a constant source of smiles and love!
I am grateful for the opportunity to be part of all of it and can't wait to see how the week unfolds!
Kristi RN, 1st time volunteer
Thursday, September 26, 2013
better security measures will protect the innocent in future. We reaffirm our commitment to bringing care and education to medical sites in Kenya, and making life-saving cervical cancer screening and treatment available to women there.
We invite you to express your comments of compassion and peace on PINCC's Facebook page.
Let Peace Prevail.
Executive Director PINCC
Tuesday, September 10, 2013
Thursday, September 5, 2013
Our trainees for VIA screening exams are mostly nurses. Many had not previously performed pelvic exams but what they lacked in experience, they have made up for with enthusiasm. They have been attentive students and have made great strides over these past two days. Our patients vary in age from 20's to 50's. Many have been referred from the HIV clinic where they have access to free anti-retroviral medications. Many have never had any form of cervical cancer screening before.
We are fortunate at this site to have a skilled gynecologist who has taken the initiative to try to create a screening program for the region.The logistical hurdles have been significant but Carol and several key members of the Kiambu Hospital staff are tackling them each one by one. Carol's commitment to this project and amazing skills of gentle persuasion have inspired us all. We are tired tonight but we will all return tomorrow refreshed and ready for our next clinic day.
Wednesday, August 28, 2013
States, and I am a first time volunteer with PINCC. I am hoping to
build on the excellent blog post that Tenay wrote on Monday about our
work in the Kibera slum of Nairobi. To say this week has been "eye
opening" is a huge understatement. It is challenging to work in an
environment with limited resources, yet continue to provide a high
standard of care. PINCC does an amazing job of stretching and
utilizing the resources that they do have. We reuse anything that can
safely be reused. Also, we do not have an autoclave large enough to
sterilize the many speculums that trainees and clinicians use when
screening approximately 35 patients each day. Therefore, there is a
very specific cleaning process that occurs to make sure that we are
thoroughly cleaning speculums and not infecting anyone.
Kibera slum is a difficult location to implement a cervical cancer
screening program. Kibera is home to an estimated 750,000 people (it
is almost impossible to accurately assess the population because
people come and go frequently) crammed into an area approximately the
size of Central Park in New York City. Many in the slum are still
unaware about what cervical cancer is, and the importance of being
screened. The women who have come to the clinic this week have been
very brave. Many of them come alone. The ones who do come often appear
anxious and state they are scared for the exam and/or finding out
their results. (Those who do not know their HIV status are also able
to have a rapid test to find out). The women who have precancerous
lesions on their cervix are usually able to have them removed the same
day. Women who discover that they are HIV positive receive counseling
and are educated about options they have for medical treatment.
Dr. Virginia Hanson, a gynecologist and our medical director this
week, has been performing the LEEP procedures. A LEEP procedure
removes dysplasias (pre-cancerous lesions on the cervix.) She told us
these are the most difficult LEEP procedures she has done in her 30+
years as a physician. In the United States, these lesions would have
been removed long before they had progressed to this point. But here
in Kibera, they are extensive and have grown close to the vaginal
wall, making removal much more challenging. Fortunately she has been
able to remove them before they progress to cancer. Unfortunately at
this time there is not a physician at Tabitha Clinic who PINCC is able
to train and certify in LEEP's, but the clinic will be working on
finding a physician who can be trained on a future PINCC trip. In the
meantime, PINCC is able to train the nurses, midwives, and clinical
officers in how to do Visual Inspection with Acetic Acid (VIA), Visual
Inspection with Lugol's Iodine, and cryotherapy.
The PINCC support staff and clinicians have remarked repeatedly how
impressed we all are with the trainees this week. They are Kenyan
nurses, nurse midwives, and clinical officers (similar to the role a
physician's assistant has in the U.S.) They are eager to learn and are
catching on quickly.
Certainly, it can be disheartening to see the difficulty that the
people of Kibera have in accessing health care or even staying healthy
in such extreme living conditions. Heart wrenching as well is seeing
cases of cervical cancer, which is an almost 100% preventable cancer.
(Dr. Virginia told me today that she only saw two cases of cervical
cancer while working as a gynecologist in the United States.) But, we
still have hope for the women of Kibera. We see the trainees who are
working very hard to learn how to do these screenings and continue to
advocate for women's health after PINCC leaves. They have learned much
these past three days and will attempt to learn as much as they can in
the next day and a half. After our team leaves, they will be expected
to continue doing as many cervical cancer screenings as possible
between now and when PINCC returns for further training in six months.
Thank you for your support of PINCC and we look forward to updating
you again later this week!
Monday, August 26, 2013
Saturday, August 24, 2013
Saturday, Aug. 17 Eight of our group arrived Saturday evening at the Mennonite Guest House (MGH), greeted each other and had out first meeting to plan our week at Bungoma Districtl Hospital. Some of our group were lucky enough to have had a side trip to Nairobi Regional Park Game Reserve today and spotted lots of plains animals…up close and personal. Three more will join us at Bungoma on Sunday.
MGH is set amidst lovely gardens and rooms are very nice.
Sunday, Aug. 18 was travel day to Bungoma. Some took a 9 hour van ride across Kenya towards the west through the beautiful hills and valleys of the Rift Valley with deep greens of the fields contrasted with the red earth The weather was changeable and beautiful cumulous clouds accompanied the whole way. Our driver, Mike Muthama, was a pleasure and answered all our numerous questions. Others opted to a flight and only a 2 ½ hour ride. We rendezvoused at the Bungoma Countryside Hotel. We will be here all week. We are two to a bungalow with our own bath.
The food is country style, potatoes, rice, shredded salad of some type and stew of either chicken or beef, pineapple for dessert. It is relatively the same every night, but the conversation is lively and improves the appetite.
Monday Aug. 19 was D Day. The first day is always a bit difficult as we learn our parts and place in situ for the first time. It's sort of like the first rehearsal of a local play. We have 4 exams rooms and one very small office. Our clients, the women of all ages, stations and education crowd to us for information on how they will be seen. The clients are very eager for this free service which impacts on their reproductive lives. Over the next several hours, question after question, step by step, both of ours and the clients' needs fell into place to get this mobile clinic in a foreign land up and running. Carol carefully answered all our questions. We had some missteps, but they were few.
We take a tea break about 10 for a sweet samosa type bun, a sausage and tea. Lunch comes about 2, of chopped kale, rice, potatoes and some type of stew. Notice the similarity here. But we sure eat it all.
The staff has showed up, doctors, nurses and clinical officer students and most are eager to learn. Our PINCC doctor clinicians are eager to teach. It is a good combination. As everywhere, the staff vary in their skills and commitment, but overall it is a motivated group. We saw 30 patients today, including LEEP. Not bad for a first day. Our Kenyan nurse- midwife, Ruth Kitai, taught a wonderful class in the waiting area, full of lots of humor, which broke the tension for the clients sitting, waiting, wondering.
Tuesday, Aug. 20 and we're moving along a good clip and we saw 40 patients today. We did 2-3 LEEPS. We couldn't train on the cryo as there was no gas. The problems we encounter in this multi-faceted endeavor seem small as the Kenyans are a pleasure to work with; polite, soft-spoken, amenable, flexible with a sweet graciousness. All the clients, doubly so…so gracious, so grateful. We often receive blessing as they exit the exam rooms after their stressful exams. We saw 50 clients today and found four cancers. One was quite advanced. Our PINCC staff can find this very hard to process as we assume the client would survive in the US, or at least receive supportive palliative care.
Wednesday, Aug. 21 Our clinicians feel the medical training is going well. All work so hard in the small, crowded rooms, hour after hour. At 3 pm every day, our Medical Director, Dr. Virginia Hanson, leads a class for the Kenyan staff. Towards the end of the day, about 3-4 pm depending, we start to gather up records, clean remaining instruments, and re stock rooms. Our office people keep us on track, which is not easy as we try to be fair re the first come first served principle, but at the same time, flexible. It ain't easy. Others of staff work hard to keep ahead of data that needs to be entered and backed up. The cryotherapy is up and running and we're doing our training.. Tonight the clinicians had a meeting to evaluate the Kenyan staff and identify those who may need more support in the learning process.
We had a special treat as about 30 Community Health Workers came in from far and wide for a class today to learn about prevention of cervical cancer and then spread the word.
Tonight we went out for pizza. We ate by candle light as due to the rains, all lights were out. This usually happens with a hard rain. We saw 50 clients today. All agreed, the day felt much more "fluid."
Thursday, Aug. 22 In spite of our breaks for tea at 10 and lunch at 1: 30 or 2 , the staff gets weary in the afternoons. We do keep going, but this is not for the lame or halt. I never work as hard all year as I do with the few weeks at PINCC. The staff knows we are leaving and I honestly feel they will hate to see us go. Today volunteer Mimi Pirard, who is a professional singer, treated our clients to a lovely French ballad. They returned the favor and sang to us. Saw another 50 clients today.
Thursday, August 15, 2013
Our PINCC team from the US arrived in Douala yesterday. More than half of the team boarded the plane for home or a well-deserved vacation in Paris! while Carol, Monica and myself hugged and waved them goodbye, our feet still on Cameroonian soil.
It has been an exciting, exhausting adventure, full of learning, surprises, pot-holes, ice-cream, Monkey fruit, car & moto horns, and many cervices!!
The week in Yaounde at the Bethesda Hospital ended well. The group of trainees we worked with were ready and excited to continue to use their new skills- correctly identifying the GSC (squamocolumnar junction in French) and by the end of the week were more confidently deciding whether an exam was "adequate" or "inadequate" and "positive" or "negative". One gynecologist, Fidelia, exceeded expectations and was certified in VIA on the first visit!
In Yaounde we screened 189 patients (according to Shelby's and Reid's fine statistics), did 42 Pap smears, 5 biopsies, 2 LEEPs and 4 cryos. As we went around in a circle during our closing ceremony, sharing what we learned, there were tears and laughter. Monica learned even with language barriers we can still communicate (although all French speakers out there, get excited about Cameroon!) and I learned (which served me well in Kumba) that it is often necessary & incredibly helpful to get down on one's knees to do a proper speculum exam & adequately visualize a cervix!
From Yaounde to Douala in Dr.Nkeh's van we traveled (our driver is a car doctor and has even written a manual on car maintenance for other drivers in Cameroon) so we always felt very safe in his vehicle. Although safe, we also felt cramped and hot as we made our way to the humid and rainy climate in Kumba, 2-3 hours north of Douala.
On our journey, we passed rows and rows of banana, palm and rubber trees. We went through many toll booths which consisted of a man standing in the middle of the street collecting coins from the passing vehicles. Our adventure began as we attempted to find a place to stay in Kumba. After Dr.Nkeh's car got stuck in the mud, requiring all of our female strength to push it out, we arrived at a hotel and finally were able to stretch our legs.
In Kumba we were welcomed by Stella, a nurse in Cameroon, who originally motivated PINCC's trip to Cameroon. Stella is a passionate, dedicated nurse who opened her own medical clinic- We Care- in the Kosala neighborhood of Kumba. I leaned from both Stella & Carol that Stella found PINCC on the Internet, and continued to write to Kay many, many times until Kay was finally able to make the trip to Cameroon, one year ago. Stella's dedication & commitment to her patients brought PINCC to the We Care clinic to continue to teach Stella and other nurses, nursing assistants and lab technicians (who routinely do many vaginal exams) VIA and cryotherapy. Although Stella's clinic has minimal resources, Stella is a fighter and she will continue to bring many resources to her clinic to better serve her patients.
Although we were only in Kumba for less than 3 full days we screened 137 patients, did 49 Paps, 1 biopsy, 1 LEEP and 6 cryos.
I know I, and I think it is safe to say the other PINCC volunteers from the US will leave Cameroon touched by many amazing individuals we had the opportunity to meet.
We will also be leaving with dresses, skirts, pants and shorts handmade by an incredibly skilled Cameroonian seamstress, with fabric we purchased in Yaounde! The very-fashionable seamstress, Mercy, took our measurements one day and the next day an after-work fashion show took place as we modeled our new attire, which brought delight to all!
It was exciting for me to be a part of PINCC's first trip to Cameroon- according to Carol, Cameroon was a success. After spending the last couple weeks with Carol, not only do I attempt to emulate her and channel her patience and calm in times of chaos, but I trust her word 100%.
Tomorrow, Monica will head back to the US and Carol and I plan to fly to Kenya. We hope for safe travels, good luck and we look forward to many more "wow" moments along the way!!
Tuesday, August 6, 2013
The PINCC team from the US- Carol, Dr.Melissa, Debra, Reid, Shelby, Dr.Amy, Dr.Katie, Dr.Christina and Monica- arrived safely, Carol holding a sign & awaiting our arrival as we passed through customs & finally exhaled.
Dr.Melissa's bag was lost en route, deciding to take a side trip to either Atlanta or Paris- but will hopefully be found & arrive tomorrow. Thank goodness Dr.Melissa's daughter, Shelby, is here for mother-daughter clothes sharing!
Daily DEET, nightly romantic mosquito nets, Carol's stock in bottled water and Carol's ban on fresh vegetables has kept us all relatively healthy:)
Daily adventures include Debra, Reid & Shelby all getting locked in the bathroom! Carol & Amy's adventure to find an "aspirador petite" and delicious adventures with Cameroonian cuisine- fried fish, meat stews, fried chicken, (we've all given up on vegetarianism) Irish potatoes! pizza! pancakes!
The Cameroonian participants are wonderful, motivated, smart & learning quickly. Today we did 41 exams and a patient even danced out of the clinic room after her VIA exam was "adequate" and "negative"!!
We are off to a good start in Cameroon, many smiles on all our faces:))
Saturday, June 15, 2013
I am always doing that which I can not do, in order that I may learn how to do it. - Picasso
by Tina Romenesko
As we wandered through the soggy streets toward the clinic, we were all a little sad that this is our last day. It has been challenging, and fulfilling, and wet, and long, and filled with laughter, tears, good news, bad news, and lots of hard work. Each of us has been challenged to do, to see, to be, something that stretches our edges. In service work, expecting the unexpected is the norm. We only saw 30 patients today (instead of 45-50) because we needed to clean all the speculums and pack up the PINCC suitcases with equipment and supplies. The Nicaraguan trainees also took their written tests and all agree that they have learned A LOT in the past five days.
Today there was a cancer diagnosis, which is always a staggering reality. This woman has four sons - the youngest is six - and she will have to go to Managua, as soon as possible, for more diagnostic tests and treatment. She doesn't have the money for the trip and hopes she can find help affording treatment. Many women die because they can't afford treatment. Joyce and I were called in to bring her to a quiet space to process the bad news. Joyce is our PINCC team grandmother that has spent the past two weeks walking through puddles and up and down cobblestones with her two walking sticks. Despite having MS, Joyce has ridden on boats, walked the beach, and held many hands during our time in Pearl Lagoon. A fierce warrior with the biggest heart I have ever known, she offered sage advice. "Take it one step at a time. Talk to your family - and remember its okay to ask for help." I held this brave woman's hand and told her about my son that is a 21 year cancer survivor, diagnosed at age 6. We drank apple juice, and she talked again with Dr. Sharry to ask a few more questions before taking the bus back home.
Around 2:30, Carol brought us all together, instructing us to blow up two balloons and tie them around our ankles. Really? Some of us were better at inflation and others at tying, and eventually we were all set for her ice breaker. Amidst squeals and laughter, we tried to pop each others balloons, until there were only two left standing: Jaya and the trainee, Inez. It was a great way to release the stress of the week and come together as a group again. Each of member of the PINCC group shared what they had learned/loved on the trip and about Nicaragua. Sally translated for those that didn't speak Spanish and the consensus was that it was a very valuable week of learning and listening. Many of the Nicaraguan trainees wanted to share also - expressing their gratitude and looking forward to our return in November. PINCC will return to Pearl Lagoon every six months to check on the trainees and continue educating them in these life saving techniques. Each visit they are progressively moved forward until they are able to perform all of the available treatments independently. This process usually takes about 3 years and there are always new trainees with each visit, so everyone progresses at their own pace.
The rain continued to fall as we headed our separate ways, filled with appreciation, and wiser for having experienced this amazing week together.
The Good, the Bad, and the Hopeful
by Sallie Weissinger
Each morning the PINCC clinicians train the local doctors and nurses while non-medical volunteers interview the day's 45 patients, noting their medical histories and highlighting details that might be of interest to the clinicians (previous PAP or biopsy results that turned out positive, for example). Then we log the sheets and pass them on to the PINCC nurses and doctors and the local trainees for their breast exams, pelvic exams, and visual inspections.
On Thursday Mary Johnson came to the clinic for a PINCC exam. A stylish, poised, articulate divorced woman in her late thirties, Mary is a school teacher with three daughters. When the interviewer asked when she had her last PAP test, Mary said it had been more than five years. She said she'd been too busy teaching her students and taking care of her daughters. The interviewer - that was me - said the best way for her to take care of her students and her daughters was to have a regular PAP test. She said she knew that and would make sure to have her PAPs in the future. We talked at some length about the importance of regular check-ups.
I also asked whether she currently had a husband or partner. She said she didn't want to be with a man because she didn't trust one to not abuse her daughters. She said that her children were her major concern - they were pre-teens and teenagers, and she would not put them at risk. I wished her well, she promised me again she would take care of herself, and I assumed her exam would turn out well.
Thursday night, as is often the case, the entire group got together before dinner to socialize. Program Coordinator Carol Cruickshank, whose energy, dedication, and kindness simply never flag, asked us to share our impressions about what we had seen this week. She specifically asked us to focus on the pain we had experienced and asked us to share coping strategies. As part of the gathering, the doctors and nurses opened up about their patients. I learned that two of our doctors had seen Mary and that it didn't look good. Because her cervix wasn't entirely visible, they had to do a rectal exam and felt a bulky area that was suspicious for cancer. They ordered a biopsy, with results to come back from Managua in two months, and a PAP smear. The PAP came back as normal, but her situation is still concerning. Both doctors are hoping for a possible non-cancerous diagnosis - extremely bad endometriosis? post-menopausal atrophy (although Mary isn't post-menopausal)? - the outcome isn't promising, but they hold a glimmer of hope.
How do the PINCC doctors and nurses deal with the reality of a likely devastating outcome for Mary? Both Pamela Lotke, our medical director, and gynecologist Sharry Kreitlow say they usually are able to focus on the many patients they can help rather than on the occasional patient with certain or almost-certain cancer. The good results far outweigh the bad. But Pam's misted-over eyes and Sharry's serious tone of voice showed that they can't always focus only on the good side of their work. We all were silent after they spoke, silently hoping for the unlikely: a good outcome for Mary, her children, and her students.
Plain Talk in Pearl Lagoon
by Sallie Weissinger
Several of the volunteers and doctors speak fluent Spanish; many more, while not fluent, speak Spanish well enough to interview patients in Nicaragua, picking up key details of their medical histories. We thought before coming here that in the Pearl Lagoon area many of the people spoke English, but weren't prepared for the fact that their English and our English weren't the same. Here the prevailing language is Creole, English spiced with its own Caribbean flavor.
Our patients' names sound English: we've seen women named Brenda, Joyce, Ellen, Jenny, and Mary. Their surnames are Fox, McCoy, Williams, and Temple, names that sound like those of friends back home. But, in the beginning of the week, when they began talking with us during the PINCC intake process, the challenge began. It's been even more daunting with women of indigenous Miskito origin.
As the week has progressed, we've improved in asking questions and understanding the women's answers. And when we've faltered, we've been able to enlist local clinic staff to interpret for us.
First, we don't ask for an address. We ask the village and the barrio (sector). Sometimes a woman gives a description: two miles from village X, next to the church or across the street from the hardware store. If we want to know her phone number, we don't ask about her phone (that means landline); she will say "I no have phone." You ask for her cellular number. Sometimes she has one, sometimes she doesn't.
Asking about a woman's medical history has gotten easier, as we have learned, in our various ways, how to frame questions. The hardest thing for me to ask about was total number of pregnancies, including miscarriages. It got easier once I began asking "How much baby born alive? How much childs alive now? How much baby born to blood (miscarriages)?" and then have summarized for understanding, asking, " Five times pregnant? One baby die in blood? One baby die age two? You have three children live now?"
Another potential misunderstanding was cleared up after a patient told me she'd been pregnant four times and had five children. I asked her to repeat her comment. She said, "One appear at two baby." I said, "twins?" and she didn't understand. So I said "gemelos", Spanish for twins, and she said yes.
We also want to know how they delivered their children - vaginally or by C-section. For a vaginal delivery, they say "normal" and flush the back of their hand down their laps, between their legs. For a C-section they simply say "cut." (For tubal ligation, or "ligadura de trompas," they say "cut to not have baby" and then there's "cut out womb", or hysterectomy. For the few women we've seen who have had hysterectomies, we ask the reason they had the operation. If it was because of a cancerous tumor, we will examine them. If it was because of fibroids or some other reason, we don't examine them because they don't run a risk of cervical or related cancer.)
There are other translations we've learned: diabetes is "sugar problem"; they often say "sick" instead of menstrual period. And so on....
By the end of the week, I've found myself talking my version of Creole 'Crenglish?"), asking "How much childs you have?" without putting "did" and "do" in front of my verbs. I've been dropping the definite article "the" and the occasional preposition and talking primarily in present tense. I wonder how I sound to the warm, welcoming people of this area. They listen to my questions and answer them as fully as they can, at times squinting to show me I need to repeat, using different words. They can't know that I would love to be able to replicate the musical lilt of their Jamaican-sounding (to me) accent. To me, it's what a smile would sound like, if smiles had sounds.